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PubMed1996

Building bridges for future practice: an innovative approach to foster critical thinking.

Developing mechanisms to uncover and share with students the deep richness of practice through reflective, collegial, and supportive dialogue is a very timely and necessary activity. How this compliments other educational strategies and the impact of the full expression of practice dialogue continues to be created and discovered. While practice dialogue can influence experimental knowledge development, it does not negate the necessity of the student's active engagement in direct practice learning episodes with the clinical faculty. Preliminary evaluations by staff nurses and students are positive. Staff nurses have identified a "therapeutic" effect in sharing their practice dialogue. Due to the early phase of implementation, other outcome data are not available. In this project, "Critical Thinking Rounds" are being developed as a mechanism to begin to uncover critical thinking in practice. Based on the excitement of nurses and students coming together and sharing practice, similar activities need to be facilitated as essential mechanisms for expressing the essence of nursing practice in the hope of bridging the gap between education and practice.

Clinical Competence↗

PubMed2006

Auditory processing during deep propofol sedation and recovery from unconsciousness.

OBJECTIVE: Using evoked potentials, this study investigated effects of deep propofol sedation, and effects of recovery from unconsciousness, on the processing of auditory information with stimuli suited to elicit a physical MMN, and a (music-syntactic) ERAN. METHODS: Levels of sedation were assessed using the Bispectral Index (BIS) and the Modified Observer's Assessment of Alertness and Sedation Scale (MOAAS). EEG-measurements were performed during wakefulness, deep propofol sedation (MOAAS 2-3, mean BIS=68), and a recovery period. Between deep sedation and recovery period, the infusion rate of propofol was increased to achieve unconsciousness (MOAAS 0-1, mean BIS=35); EEG measurements of recovery period were performed after subjects regained consciousness. RESULTS: During deep sedation, the physical MMN was markedly reduced, but still significant. No ERAN was observed in this level. A clear P3a was elicited during deep sedation by those deviants, which were task-relevant during the awake state. As soon as subjects regained consciousness during the recovery period, a normal MMN was elicited. By contrast, the P3a was absent in the recovery period, and the P3b was markedly reduced. CONCLUSIONS: Results indicate that the auditory sensory memory (as indexed by the physical MMN) is still active, although strongly reduced, during deep sedation (MOAAS 2-3). The presence of the P3a indicates that attention-related processes are still operating during this level. Processes of syntactic analysis appear to be abolished during deep sedation. After propofol-induced anesthesia, the auditory sensory memory appears to operate normal as soon as subjects regain consciousness, whereas the attention-related processes indexed by P3a and P3b are markedly impaired. SIGNIFICANCE: Results inform about effects of sedative drugs on auditory and attention-related mechanisms. The findings are important because these mechanisms are prerequisites for auditory awareness, auditory learning and memory, as well as language perception during anesthesia.

Adult↗

PubMed1993

Interpositus lesion abolition of the eyeblink conditioned response is not due to effects on performance.

Classical conditioning of the rabbit eyeblink response was used to study the effects of cerebellar lesions on performance in animals trained with low-intensity unconditioned stimuli (US). Animals were trained with 1 of 2 low-intensity corneal-airpuff USs paired with a tone-conditioned stimulus. This study confirms earlier findings demonstrating the differential effects of lesions of deep cerebellar nuclei on the conditioned (CR) and unconditioned responses (UR). Lesions of the anterior interpositus nucleus of the cerebellum in animals that were successfully conditioned abolished CRs without affecting UR performance.

Animals↗

PubMed1990

Origin and organization of the zebrafish fate map.

We have analyzed lineages of cells labeled by intracellular injection of tracer dye during early zebrafish development to learn when cells become allocated to particular fates during development, and how the fate map is organized. The earliest lineage restriction was described previously, and segregates the yolk cell from the blastoderm in the midblastula. After one or two more cell divisions, the lineages of epithelial enveloping layer (EVL) cells become restricted to generate exclusively periderm. Following an additional division in the late blastula, deep layer (DEL) cells generate clones that are restricted to single deep embryonic tissues. The appearance of both the EVL and DEL restrictions could be causally linked to blastoderm morphogenesis during epiboly. A fate map emerges as the DEL cell lineages become restricted in the late blastula. It is similar in organization to that of an amphibian embryo. DEL cells located near the animal pole of the early gastrula give rise to ectodermal fates (including the definitive epidermis). Cells located near the blastoderm margin give rise to mesodermal and endodermal fates. Dorsal cells in the gastrula form dorsal and anterior structures in the embryo, and ventral cells in the gastrula form dorsal, ventral and posterior structures. The exact locations of progenitors of single cell types and of local regions of the embryo cannot be mapped at the stages we examined, because of variable cell rearrangements during gastrulation.

Animals↗

PubMed2026

Donor Microbiota Features Associated With Liver Transplant Recipient Infectious Complications: A Pilot Study Using Deep Intestinal Sampling During Liver Procurement.

BACKGROUND: The gut microbiota of living organ donors has been linked to transplant outcomes. However, little is known about the characteristics of the deceased donor gut microbiota or its potential impact on recipient outcomes. METHODS: We analyzed the deep intestinal microbiota from 24 deceased donors. Samples included luminal stool from the right and left colon as well as bile. Microbial composition was characterized using 16S V4 rRNA sequencing. α- and β-diversity analyses were performed to compare microbial communities between donor enteric sites and against stool samples from 28 healthy community controls, 14 critically ill intensive care comparators, and 12 matched liver transplant recipients. Machine learning models and logistic regression analysis were applied to explore whether features of the donor microbiota could predict recipient post-transplant complications. FINDINGS: The deceased donor microbiota showed an absence of the expected compositional variability between sampling sites, with no significant differences in either α- or β-diversity observed between bile, right and left colonic samples (all p > 0.05). Donor samples exhibited distinct microbial profiles compared with stool from both healthy and ICU comparators, including increased abundance of potential pathogens within the Enterobacteriaceae family (all p < 0.001). Features of the donor microbiota, particularly enrichment of Enterobacteriaceae, were associated with an increased risk of early post-transplant infection in recipients (≤ 30 days; p = 0.011). INTERPRETATION: The deceased donor gut microbiota may represent a distinct microbial community with potential clinical relevance. Microbial profiling of donor enteric microbiota may help identify recipients at heightened risk of early post-transplant infectious complications.

Enterobacteriaceae↗

PubMed2002

A conceptual review of the psychosocial genomics of expectancy and surprise: neuroscience perspectives about the deep psychobiology of therapeutic hypnosis.

This conceptual review explores some speculative associations between the neuroscience of expectancy and surprise during stress and therapeutic hypnosis. Current neuroscience is exploring how novel interactions between the organism and the environment initiate cascades of gene expression, protein synthesis, neurogenesis, and healing that operate via Darwinian principles of natural variation and selection on all levels from the molecular-genomic to the subjective states of consciousness. From a neuroscience perspective, the novel and surprising experiences of consciousness appear to have as important a role as expectancy in memory, learning and behavior change in the psychobiology of therapeutic hypnosis. This paper explores how we may integrate the psychosocial genomics of expectancy and surprise in therapeutic hypnosis as a complex system of creative adaptation on all levels of human experience from mind to gene expression.

Adaptation, Psychological↗

PubMed2004

Exploring the counterion atmosphere around DNA: what can be learned from molecular dynamics simulations?

The counterion distribution around a DNA dodecamer (5'-CGCGAATTCGCG-3') is analyzed using both standard and novel techniques based on state of the art molecular dynamics simulations. Specifically, we have explored the population of Na(+) in the minor groove of DNA duplex, and whether or not a string of Na(+) can replace the spine of hydration in the narrow AATT minor groove. The results suggest that the insertion of Na(+) in the minor groove is a very rare event, but that when once the ion finds specific sites deep inside the groove it can reside there for very long periods of time. According to our simulation the presence of Na(+) inside the groove does not have a dramatic influence in the structure or dynamics of the duplex DNA. The ability of current MD simulations to obtain equilibrated pictures of the counterion atmosphere around DNA is critically discussed.

Binding Sites↗

PubMed2004

Deep change. How operational innovation can transform your company.

Breakthrough innovations--not just steady improvements--in operations can destroy competitors and shake up entire industries. Just look at Dell, Toyota, and Wal-Mart. But fewer than 10% of large companies have made serious attempts to achieve operational innovation. Why? One reason, contends the author, is that business culture undervalues operations--they're not as sexy as deals or acquisitions. In addition, many executives who rose through the ranks of finance or sales aren't familiar with operations--and they aren't interested in learning more. Finally, because no one holds the title Vice President of Operational Innovation, it doesn't have a natural home in the organization, so it's easily overlooked. Fortunately, all of these barriers can be overcome. This article offers practical advice on how to develop operational innovations, such as looking for role models outside your industry to emulate and identifying--and then defying--constraining assumptions about how work should be done. The author also discusses the best way to implement operational innovations. For instance, because they are disruptive by nature, projects should be concentrated in those activities with the greatest impact on enterprise strategic goals. Operational innovation may feel unglamorous or unfamiliar to many executives, but it is the only lasting basis for superior performance. Executives who understand how operational innovation happens--and who understand the barriers that prevent it from happening--can add to their strategic arsenal one of the most powerful competitive weapons in existence. In an economy that has overdosed on hype and in which customers rule as never before, operational innovation offers a meaningful and sustainable way to get ahead--and stay ahead--of the pack.

Commerce↗

PubMed2006

Levels-of-processing effects in first-degree relatives of individuals with schizophrenia.

BACKGROUND: First-degree relatives of individuals with schizophrenia show cognitive impairments that are similar to but less severe than their ill relatives. We have shown that memory impairments can be improved and prefrontal cortical (PFC) activity increased in individuals with schizophrenia by providing beneficial encoding strategies. The current study used a similar paradigm to determine whether siblings of individuals with schizophrenia (SIBs) also show increases in brain activity when presented with beneficial encoding strategies. METHODS: Twenty-one SIBs and 38 siblings of healthy comparison subjects underwent functional magnetic resonance imaging scans while engaged in deep (abstract/concrete judgments) and shallow (orthographic judgments) encoding. Subjects were then given a recognition memory test. RESULTS: The groups did not differ on encoding or recognition accuracy, and the SIBs benefited from deep encoding to a similar degree as control subjects. The SIBs showed deep encoding-related activity in a number of PFC regions typically activated during semantic processing. However, SIBs showed more activity than control subjects in three subregions of PFC (left BA 44 & BA 47 bilaterally). CONCLUSIONS: Siblings of individuals with schizophrenia benefit from supportive verbal encoding conditions. Like individuals with schizophrenia, SIBs also show increased task-related activity in a larger number of PFC subregions than control subjects during deep verbal encoding.

Adolescent↗

PubMed2003

Pretraining enhances recovery from visuospatial deficit following cerebellar dentate nucleus lesion.

Following bilateral lesions targeting lateral deep cerebellar nuclei, rats were subjected to a bridge test as a measure of visuomotor coordination and were trained on the Morris water maze (MWM) as a measure of visuospatial processing. Lesioned rats were significantly impaired in visuospatial processing, but not visuomotor coordination, relative to sham rats. In a 2nd experiment, rats were pretrained on a delayed spatial alternation task (T maze) before MWM training. Pretraining reversed the visuospatial deficit caused by the lesions as compared with nonpretrained rats. Results suggest that lateral deep cerebellar nuclei contribute to visuospatial processing with a negligible contribution to visuomotor skills and that visuospatial deficits resulting from lateral nuclei damage can be reversed with pretraining on aspatial working memory task.

Animals↗

PubMedDate not supplied

A novel inexpensive IV catheterization training model for paramedic students.

INTRODUCTION: Teaching paramedic students venipuncture and intravenous catheterization has traditionally relied on bulky, expensive phlebotomy models. A gelatin intravenous model (GIM) costing less than 50 cents is currently being used in the training of medical students and interns. The study objective was to evaluate paramedic students' perceptions of the GIM as a training tool. METHODS: GIMs are created using gelatin, psyllium, Penrose drains, food coloring, salt, and water. Penrose drains are filled with artificial blood composed of salt water and food coloring. The drains are placed in an aluminum pan with a base of hardening gelatin, with half-inch drains at the bottom of the pan and quarter-inch drains higher up in layers of mixed psyllium and gelatin to simulate deep and superficial veins respectively. A convenience, volunteer sample of 14 paramedic students who previously trained with traditional phlebotomy models each made two to five attempts at intravenous insertion using the GIM. Perceptions of the GIM were measured using a Likert scale (1, worst rating; 5, best rating). Means are reported. RESULTS: Study subjects rated ease of use at 4.17, realism at 4.07, and effectiveness in learning intravenous insertion at 4.28. GIM as a more effective teaching tool than the conventional rubber arm yielded a rating of 4.14. CONCLUSIONS: This study is limited by a small sample size, and further studies evaluating the GIMs construct and content validity are needed. Despite these limitations, given the GIMs simplicity and value, paramedic instructors may wish to consider implementation of this device in their training programs.

Adult↗

PubMed2004

Comparative cognitive effects of bilateral subthalamic stimulation and subcutaneous continuous infusion of apomorphine in Parkinson's disease.

Bilateral subthalamic deep brain stimulation (STN-DBS) and continuous subcutaneous infusion of apomorphine (APM-csi) can provide a comparable improvement on motor function in patients with advanced Parkinson's disease (PD), but the mechanisms by which both therapies exert their effects are different. We analyzed the cognitive effects of APM-csi. We also compared neuropsychological effects induced by STN-DBS and APM-csi in advanced PD to ascertain the neuropsychological aspects relevant in determining the therapeutic procedure that is the most appropriate in a particular patient. We studied 9 patients treated with STN-DBS and 7 patients with APM-csi. Neuropsychological measures included Rey's Auditory-Verbal Learning, Stroop, Trail Making, phonetic verbal fluency, and Judgment of Line Orientation tests. In the APM-csi group, significant changes were not observed in the neuropsychological tests performance. By contrast, in the STN-DBS group, moderate worsening was found in phonetic verbal fluency and Stroop Naming scores that was partially reversible at long-term follow-up and did not have consequences on regular activities. Consequently, these findings could be interpreted as being not relevant in deciding the most suitable treatment in a given patient.

Aged↗

PubMed1994

Decision trees based on automatic learning and their use in cardiology.

Computerized information systems, especially decision support systems, have become an increasingly important role in medical applications, particularly in those where important decision must be made effectively and reliably. But the possibility of using computers in medical decision making is limited by many difficulties, including the complexity of conventional computer languages, methodologies and tools. Thus a conceptual simple decision making model with the possibility of automating learning should be used. In this paper we introduce a cardiological knowledge-based system based on the decision tree approach supporting the mitral valve prolapse determination. Prolapse is defined as the displacement of a bodily part from its normal position. The term mitral valve prolaps (PMV), therefore, implies that the mitral leaflets are displaced relative to some structure, generally taken to the mitral annulus. The implications of the PMV are the following: disturbed normal laminar blood flow, turbulence of the blood flow, injury of the chordae tendinae, the possibility of thrombus's composition, bacterial endocarditis, and finally hemodynamic changes defined as mitral insufficiency and mitral regurgitation. Uncertainty persists about how it should be diagnosed and about its clinical importance. It is our deep belief that the echocardiography enables properly trained experts armed with proper criteria to evaluate PMV almost 100%. But unfortunately, there are some problems concerned with the use of echocardiography. In that manner we have decided to start a research project aimed at finding new criteria and enabling the general practitioner to evaluate PMV using conventional methods and to select potential patients from the general population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2005

Using errorless learning to treat letter-by-letter reading: contrasting word versus letter-based therapy.

Some pure alexic readers have been shown to activate lexical and semantic knowledge under brief presentation conditions. This ability is not seen when letter-by-letter reading accuracy is high or the reading impairment is very severe. It is also unlikely to occur under normal untimed presentation because the pure alexic will make deliberate use of their letter-by-letter strategy. This paper presents data from a moderately severe letter-by-letter reader, FD, who had visual processing problems affecting reading. He also had other mild aphasic characteristics. FD showed implicit reading abilities under brief presentation conditions, being able to make lexical decisions and semantic categorisations well above chance. FD was given two therapy programmes, the first, whole word therapy to exploit this implicit ability and the second to improve letter-by-letter accuracy and speed. FD showed some improvement in reading ability after both therapy programmes, particularly for words of personal interest to him. His letter naming accuracy and reading of visually similar words were the most resistant to change. A striking effect of therapy was the cessation of FD's letter-by-letter reading and the emergence of some of the characteristics of deep dyslexia. Even when therapy concentrated on letter accuracy, FD did not revert back to his original letter-by-letter reading strategy. The results are discussed with reference to the two theories of pure alexia. Some conclusions are drawn about the need for therapists to examine and exploit all residual reading skills when devising therapeutic programmes.

Acoustic Stimulation↗

PubMed1998

Skin biopsy techniques for the internist.

OBJECTIVE: To review three commonly performed skin biopsy procedures: shave, punch, and excision. DATA SOURCES: English-language articles identified through a MEDLINE search (1966-1997) using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and cross-references. STUDY SELECTION: Articles that reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care. DATA EXTRACTION: Information was manually extracted from all selected articles and texts; emphasis was placed on information relevant to internal medicine physicians who want to learn skin biopsy techniques. DATA SYNTHESIS: Shave biopsies require the least experience and time but are limited to superficial, nonpigmented lesions. Punch biopsies are simple to perform, have few complications, and if small, can heal without suturing. Closing the wound with unbraided nylon on a C-17 needle will enhance the cosmetic result but requires more expertise and time. Elliptical excisions are ideal for removing large or deep lesions, provide abundant material for many studies, and can be curative for a number of conditions, but require the greatest amount of time, expertise, and office resources. Elliptical excisions can be closed with unbraided nylon using a CE-3 or FS-3 needle in thick skin or a P-3 needle on the face. All specimens should be submitted in a labeled container with a brief clinical description and working diagnosis. CONCLUSIONS: Skin biopsies are an essential technique in the management of skin diseases and can enhance the dermatologic care rendered by internists.

Biopsy↗

PubMedDate not supplied

A literature review: oral irrigation therapy. The adjunctive roles for home and professional use.

It is now recognized that there are several different types of periodontal infections. As we learn more about the cause of these diseases, it becomes obvious that we have treatment options. A successful choice of procedures for each individual depends on an accurate diagnosis based on comprehensive data collection of clinical and microbiological findings. Treatment choices include a non-surgical phase which consists of plaque removal, plaque control, scaling, root planing, and the use of chemical agents. For complete debridement of deep pockets, furcations or areas with root surface irregularities, surgical access may be necessary. When considering drug therapy, it must be noted that systemic antibiotics may be necessary to suppress those subgingival periodontal pathogens which have the ability to invade the tissue and resist other methods of eradication. Removal or alteration of pathogenic flora is mandatory to improve a patient's periodontal health. The extensive use of supragingival irrigation as an adjunct for treating gingivitis has led to the interest in subgingival irrigation as a possible adjunct for treatment of periodontal diseases. Targeted lavage and subgingival delivery of effective antimicrobial agents show potential as supplemental office procedures or as a component of a home oral hygiene regime. Additional research is needed to develop more efficacious chemotherapeutic substances than are currently available and to further define the optimum application of each. Substantive medicaments that react specifically against periodontopathic organisms are essential. Exact frequency and duration of professionally-applied and self-administered subgingival irrigation need to be determined for maximum results. Further investigation is required to establish the potential role of adjunctive irrigation and antimicrobial therapy in the treatment of periodontitis. Yet, another important application of irrigation has been recognized. Recently, the American Heart Association revised its guidelines for the prevention of bacterial endocarditis. The amendments to the dentistry sections have been approved by the Council on Dental Therapeutics of the American Dental Association. Included in this text is the recommendation that as an adjunct to antibiotic prophylaxis, sulcular irrigation with chlorhexidine may be useful for those patients considered high risk and/or have poor oral hygiene. Irrigation therapy is undergoing extensive scrutiny in the scientific research community. Presently, considerable conclusive evidence exists to suggest that adjunctive irrigation may play an important role in controlling gingivitis and periodontitis. The overwhelming challenge for any and all successful periodontal therapy will always remain dependent on patient compliance to regular professional and home care.

Anti-Bacterial Agents↗

PubMed1995

A new, simplified posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy.

OBJECTIVE: A new surgical technique of creating a prophylactic, reconstructive posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy is described. The procedure restores the pelvic topography and gross and functional anatomy after removal of the uterus. A systematic order of the operation, its safety and effectiveness are presented and illustrated. METHODS: This surgical technique has been studied for 10 years, from 1983 to 1993, in a group of 250 patients with ages ranging from 19 to 76 years, average age 43 years (Caucasian, n = 178; black, n = 61; and Asian, n = 11). The following new elements were introduced to achieve post-hysterectomy restoration of the posterior cul-de-sac and vaginal vault suspension: the deep layer of the uterosacral ligaments and pararectal-paravaginal fascia are incorporated for reconstructive posterior culdoplasty; the cardinal ligaments and the deep and superficial layers of the uterosacral ligaments are used for anatomical vaginal vault suspension from the latero-posterior aspect of the vaginal wall. RESULTS: This study has documented a good outcome and effectiveness of the operation as well as good postsurgical patient satisfaction, with no symptomatology or signs of dysfunctional vagina, vaginal prolapse or enterocele formation. CONCLUSION: This new prophylactic procedure is effective, safe, simple to learn, easy to carry out, and adds very little on to the overall surgical time. Restoration of the pelvic topography, functional anatomy, prevention of dysfunctional vagina, vaginal prolapse and pelvic hernia (enterocele) formation can be achieved by following this technique. Post-hysterectomy dysfunctional vagina, vaginal prolapse and pelvic hernia formation are preventable occurrences when a surgical operation is appropriately selected and properly executed.

Adult↗

PubMed1987

Circuitry of the frontal association cortex and its relevance to dementia.

The prefrontal cortex reaches its peak size and complexity in the human brain where it occupies more than a quarter of the cerebral cortical surface. This paper reviews studies on that portion of the prefrontal cortex that is buried in and around the principal sulcus of macaque monkeys and corresponds to Brodmann's area 46 in man. Neuropsychological research as well as neurophysiology and 2-deoxyglucose metabolic mapping indicate that the principal sulcus is essential for regulation of motor behavior by internalized representations of visuo-spatial events. Conversely, the prefrontal cortex is unnecessary for behavior regulated by external stimuli, as is the case with many associative learning and recognition memory processes. Research over the past decade suggests that the principal sulcus accomplishes its regulatory functions by its interconnections with (1) the posterior parietal cortex which provides it with access to visuo-spatial data, (2) the parahippocampal gyrus and subiculum which allows information to be held 'on line' and deposited in long-term storage, and (3) motor centers such as the basal ganglia, deep layers of the superior colliculus and several premotor areas that control head, eye and hand movements. In addition, modulatory influences on prefrontal functions are exerted by (4) dopamine-, norepinephrine- and serotonin-containing fiber systems that originate in the brain stem and innervate the prefrontal cortex in a selective manner. Comparison between syndromes present in patients with a variety of diagnoses and human and nonhuman subjects with prefrontal injuries provides suggestive evidence that prefrontal dysfunction may underly the disordered thinking and abnormal social and affective responses found in many of these diseases. Accordingly, knowledge of the neural mechanisms underlying cognitive processing in nonhuman primates should be helpful in the analysis of the 'neurology' of many neurological and psychiatric illnesses.

Animals↗